Established Patient Office Visit (level 1) at St. Joseph Health Madison Hospital
100 West Cross Street, Madisonville, TX · CommonSpirit Health · · NPI 1780731737
$179.38
Cash price Discounted cash price What a hospital charges a self-pay patient who pays directly, without going through insurance — usually well below the gross charge. Example: A CT scan has a $3,200 gross charge but an $850 discounted cash price. Ask for it by name when scheduling — hospitals don't always advertise it up front.
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What you pay up front if you don't use insurance.
$1,025.00
Gross charge Gross charge (chargemaster price) The hospital's full, undiscounted list price — pulled from its internal "chargemaster" price list. Almost no one actually pays this. Example: A chest X-ray has a gross charge of $1,450. The same hospital's discounted cash price for the same X-ray is $180 — the gross charge mostly anchors negotiations, not what patients pay.
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The hospital's undiscounted list price — almost no one pays this.
$4.34 with PGT vs $204.02 with UNITED — same scan, same building. Share
Negotiated rates by payer
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Negotiated rate
The price a specific insurance plan agreed to pay the hospital for a service — it varies by insurer, and even by plan within the same insurer.
Example: The same knee MRI has a negotiated rate of $904 with one insurer's PPO plan and $1,509 with another's — identical hospital, identical scan.
Full explanation →
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Negotiated rate
The price a specific insurance plan agreed to pay the hospital for a service — it varies by insurer, and even by plan within the same insurer.
Example: The same knee MRI has a negotiated rate of $904 with one insurer's PPO plan and $1,509 with another's — identical hospital, identical scan.
Full explanation →Payer ?Payer The insurance company footing the bill — Aetna, UnitedHealthcare, Medicare, and so on. Example: "Blue Cross Blue Shield" is the payer. Its negotiated rate for an MRI might be $904, while a different payer's negotiated rate for the same scan is $1,509. Full explanation → |
Plan ?Plan The specific product an insurer sells — e.g. "Blue Cross PPO 500" — which sets your deductible, coinsurance and negotiated rates. Example: Two people both insured by Aetna can owe very different amounts for the same MRI: $50 with an HMO plan's flat copay, or the full $1,200 toward a high-deductible PPO plan's unmet deductible. Full explanation → |
Negotiated rate | vs. cash |
|---|---|---|---|
| PGT | Medicare|All Plans | $4.34 | ↓ -98% |
| BCBS | Medicare|All Plans | $4.42 | ↓ -98% |
| AETNA | Medicare|All Plans | $4.42 | ↓ -98% |
| UNITED | Medicare|All Plans | $4.51 | ↓ -97% |
| AMERIVANTAGE | Medicare|All Plans | $4.56 | ↓ -97% |
| SCANHealth | Medicare|All Plans | $4.73 | ↓ -97% |
| Ambetter | Commercial|All Plans | $6.41 | ↓ -96% |
| Wellpoint | Commercial|Exchange | $6.63 | ↓ -96% |
| Wellpoint | Medicaid|All Other Plans | $8.57 | ↓ -95% |
| Wellpoint | Medicaid|STAR | $11.79 | ↓ -93% |
| Bright Health | Commercial|All Plans | $12.71 | ↓ -93% |
| Ellwood | Commercial|All Plans | $13.26 | ↓ -93% |
| Entrust | Commercial|All Plans | $14.28 | ↓ -92% |
| NX Health | Commercial|All Plans | $14.37 | ↓ -92% |
| BCBS-TX | Commercial|Blue Advantage HMO | $18.65 | ↓ -90% |
| Health Smart | Commercial|All Plans | $18.70 | ↓ -90% |
| First Health | Commercial|All Plans | $20.40 | ↓ -89% |
| Humana | Commercial|All Plans | $20.74 | ↓ -88% |
| Cigna | Commercial|All Other Plans | $21.76 | ↓ -88% |
| BCBS-TX | Commercial|Blue Premier | $21.93 | ↓ -88% |
| Aetna | Commercial|All Plans | $22.44 | ↓ -87% |
| BCBS-TX | Commercial|HMO | $23.24 | ↓ -87% |
| BCBS-TX | Commercial|PPO | $25.86 | ↓ -86% |
| PHCS | Commercial|All Plans | $28.90 | ↓ -84% |
| Multiplan | Commercial|All Plans | $30.60 | ↓ -83% |
| BCBS-TX | Commercial|Ref Lab | $34.00 | ↓ -81% |
| United | Commercial|Exchange | $77.00 | ↓ -57% |
| SUPERIOR | Medicaid|CHIP | $80.64 | ↓ -55% |
| UNITED | Medicaid|STARKIDS | $82.26 | ↓ -54% |
| UNITED | Medicaid|All Other Plans | $82.26 | ↓ -54% |
| BCBS | Medicaid|STARKIDS | $84.68 | ↓ -53% |
| SUPERIOR | Medicaid|All Other Plans | $84.68 | ↓ -53% |
| SUPERIOR | Medicaid|STAR | $116.93 | ↓ -35% |
| United | Commercial|All Other Plans | $152.00 | ↓ -15% |
| Cigna | Commercial|Local Plus | $157.92 | ↓ -12% |
| SUPERIOR | Medicaid|STARPLUS | $199.99 | ↑ +11% |
| UNITED | Medicaid|STARPLUS | $204.02 | ↑ +14% |
Visitor-reported prices
Comments
Established Patient Office Visit (level 1) at other Texas hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| Adventhealth Rollins Brook | Lampasas | $256.64 | $36.07 – $36.07 |
| BAYLOR SCOTT & WHITE MEDICAL CENTER - BRENHAM | Brenham | $134.02 | $15.44 – $112.50 |
| BAYLOR SCOTT & WHITE MEDICAL CENTER - BUDA | Suite 110 | $96.94 | $15.00 – $93.75 |
| BAYLOR SCOTT & WHITE MEDICAL CENTER - COLLEGE STATION | College Station | $134.02 | $24.07 – $112.50 |
| BAYLOR SCOTT & WHITE CONTINUING CARE HOSPITAL | Temple | $134.02 | $38.75 – $112.50 |
| BAYLOR SCOTT & WHITE EMERGENCY MEDICAL CENTER - CEDAR PARK | Cedar Park | $96.94 | $25.00 – $112.50 |
| BAYLOR SCOTT & WHITE MEDICAL CENTER HILLCREST | Waco | $134.02 | $15.00 – $106.25 |
| BAYLOR SCOTT & WHITE MCLANE CHILDREN'S MEDICAL CENTER | Temple | $134.02 | $8.82 – $112.50 |